22 October 2007 www.drinkanddrugs.net

UNDER THE INFLUENCE Alcohol advertising before the watershed WHAT’S THE POINT? Needle exchanges are worth the controversy CULTURE CHANGE Connecting black crack users with services STUFF OF NIGHTMARES Children speak out about the impact of addiction Your fortnightly magazine | jobs | news | views | research

Published by Drink and Drugs News 22 October 2007

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Editor’s letter Empowering People Interviews pulling apart drug strategy are two a penny motivated towards treatment with vouchers and at the moment – inevitable as the consultation closes incentives – effectively bribed to do anything positive for the new strategy. But the interview on Radio 4’s for themselves. Drink and Drugs News partners: Today programme was particularly disturbing – not The following morning, Dr Michael Ross featured just for the the points it raised, but for the way it on the programme to make essential balancing raised them (page 4). points: that the main reward for patients is that they Yes, it is always legitimate to question how vast are entering treatment for themselves. ‘Most patients amounts of public money are being spent. But to hate being addicts,’ he said. ‘What’s needed is to accuse mainstream treatment services of handing reinforce their self-esteem... giving up drugs has to be out illegal drugs as a reward system to ‘junkies’ was the patient’s own idea, and very frequently it is’. By a potential body blow at a time when the field needs his brief statements he rehumanised the argument, all the political support it can muster. Drug workers taking it back from the plethora of contested are used to fighting prejudice and stigma from the statistics and refocusing it on improving people’s public day in and day out, but it doesn’t help to have quality of life. Of course our drug services always misleading information aired on the BBC’s flagship need to be accountable on whether they are effective. breakfast programme, and it’s concerning to reflect But we should not let the assumption raised in the on the nature of this attack at such a politically programme – that a minute proportion of drug sensitive time. treatment works and that public money goes towards The shame was that the argument boiled down to helping treatment centres to indulge in bad practice – such pitiful logic: that drug patients need to be be the inaccurate picture that sticks.

Editor: Claire Brown t: 020 7463 2164 In this issue European Association for e: [email protected] the Treatment of Addiction Reporter: News Round-up being openly influenced by alcohol advertising David Gilliver NTA dodges fire to announce more clients in during their favourite programmes, as Don e: [email protected] treatment•Underage alcohol sales Shenker explains. 10 falling•Police authority backs law What’s the point of needle exchange? Advertising Manager: review•Middle class areas top ‘hazardous Are needle exchange programmes worth the Ian Ralph drinking’ table•Big rise in Scottish drug-related t: 020 7463 2081 controversy they attract? Justin Dunne finds deaths•Twice as many Scotsmen using class e: [email protected] evidence to support their contribution to As as women•Coaker consults with young public health. 12 Designer: people•News in brief 4 Jez Tucker Beyond the crack e: [email protected] Features Cleverly-written diversity policies will not Cover story connect black crack users with services. Subscriptions: We need to look at fundamental culture e: [email protected] Home truths change to make services relevant, says A recent Glasgow exhibition featured artwork Chris Robin. 14 Events: by children of people with drug and alcohol e: [email protected] problems. The works on display were shocking Regulars and moving, as David Gilliver reports. 6 Letters Website: Shock at Today programme attack on treatment; www.drinkanddrugs.net Getting through to the body beautifuls Website maintained by grumble on coverage of Tory report. 9 News from a conference on performance and wiredupwales.com image-enhancing drugs at Liverpool John Notes from the Alliance CJ Wellings Ltd, FDAP and WIRED Published by CJ Wellings Ltd, Moores University. 8 Are you listening to us, or is the drug strategy do not accept responsibility for the accuracy of statements made by Southbank House, Black Prince consultation a foregone conclusion, asks Daren contributors or advertisers. The Road, London SE1 7SJ Not in front of the children Garratt. 9 contents of this magazine are the Printed on environmentally friendly The government’s updated alcohol strategy, copyright of CJ Wellings Ltd, but do paper by the Background briefing not necessarily represent its views, Safe, Sensible, Social aims to reduce the or those of FDAP, WIRED and its Manson Group Ltd number of under-18s who drink. But Alcohol Prof David Clark’s part 2 on recovery. 15 partner organisations. Cover: Montage by JellyPics Concern have found that many children are Jobs, courses, conferences, tenders 16

www.drinkanddrugs.net 22 October 2007 | drinkanddrugsnews | 3 News | Round-up

News in Brief NTA dodges fire to announce Prison problems The health of prisoners with substance misuse problems is being placed at more clients in treatment risk because of underfunding and over- crowding, according to the British The National Treatment Agency has published its to improve its quality, the reporter, Mark Easton, asked: Medical Association (BMA). Prison latest figures showing more drug users in treatment. ‘What kind of oversight is it when you’ve clearly got healthcare services are struggling to The statistics, collated by Manchester University people inside the government’s treatment system cope with the record numbers of from the National Drug Treatment Monitoring System handing over free drugs and extra drugs, and in some prisoners, warned chair of the BMA’s (NDTMS), show 195,464 people in contact with cases apparently, anti-depressants and other illegal civil and public services committee Dr specialist treatment services in 2006/7 – an increase drugs, to junkies?’ Clare Jenkins. ‘Prison doctors do not of 130 per cent in the past eight years. He went on to highlight figures obtained ‘by digging have the resources, infrastructure or The good news announcement continues with an through the NTA’s data’ that just 6 per cent of people on time to assess and treat the large increase in the number of people staying in treatment or a drug treatment programme emerge free of drugs at the numbers of inmates who enter the completing successfully (80 per cent of those in end of their treatment; 70 per cent did not finish their penal system with severe mental treatment this year) and an increase in successful treatment; and only 1.7 per cent were still drug free a health and drug addiction problems completion rates of 42 per cent since March 2006. year after they finished treatment. that in many cases have led to their NTA chief executive Paul Hayes said: ‘This is good Public Health Minister, Dawn Primarolo faced a convictions,’ she said. See the next news and represents a real achievement by services in similar line of questioning from John Humphries later in DDN for full reports from the ‘Prisons England. More people are receiving the treatment they the programme. The anchorman challenged: ‘There and beyond’ conference about need and three out of four are also staying three months haven’t been huge steps forward. This [drug treatment] managing substance misuse in prison or longer, which means their treatment is likely to be programme isn’t working, is it?’ more effective in the long term.’ ‘The evidence is in the numbers of treatment,’ Ms Mediterranean liquid diet Minutes of the NTA board meeting on 9 October Primarolo countered, to be told by Mr Humphries that Binge drinking, once thought to be the reflect the NTA’s caution at the ‘slowing improvement’ in being in contact with treatment services was not the preserve of northern European the numbers accessing treatment. However Mr Hayes’ same as receiving treatment. Some of those included in countries like the UK and the report says the emerging picture for drug treatment over the statistic on people in treatment, he said, had Scandinavian nations, is on the rise in the next three years is positive and he is confident that ‘received no treatment whatsoever’. southern Europe, according to a new the Treatment Outcomes Profile (TOP) system, ‘You’re spending half a billion pounds of taxpayers’ Spanish study published in Alcoholism: introduced this year is addressing the much-needed money on this programme… you’re now proposing you’ll clinical and experimental research. emphasis on quality and effectiveness of treatment. continue this approach in the next stage of your program- While southern European countries But the day before the drug strategy consultation me?,’ he asked. The minister emphasised the difficulty of have historically had high alcohol drew to a close on 19 October, the NTA’s confident line the client group and said ‘we’re making progress, we’re consumption rates, this has mainly failed to emerge during an interview on BBC Radio 4’s leading Europe’ [in getting people into treatment]. been in the form of wine with meals. Today programme. An interview that began by Priorities for the future included piloting support However, the research – based on questioning Paul Hayes about the moral efficacy of mechanisms for people, to make their drug treatment interviews with more than 12,000 contingency management – giving drug clients more effective, she said – which was why the NTA was people in the Madrid region – found incentives to stay in treatment – turned into an attack on looking at how contingency measures had been used in that weekend binge drinking among the state of drug treatment in the UK. In response to Mr the US, as just one of a range of support options. young people was on the rise, with Hayes’ assurances that the NTA oversees drug treatment See letters, page 9 most choosing spirits rather than wine or beer. See www.blackwell- synergy.com Underage alcohol sales falling Police authority backs law review

‘Holby’ hammered Fewer pubs and shops are selling alcohol to those North Wales Police Authority has backed a review of drug Drinks industry body the Portman underage, according to the results of the Home Office- policy after chief constable Richard Brunstrom called for a Group has complained to the BBC and backed Tackling Underage Sales of Alcohol Campaign scrapping of the class A, B and C system and for the Misuse to OFCOM about an episode of Holby (TUSAC). of Drugs Act to be replaced by a ‘substance misuse act’ City which it claimed featured a ‘highly Less than 15 per cent of the 9,000 premises targeted based on a ‘hierarchy of harm’ that also included nicotine irresponsible portrayal of excessive by police and trading standards officers sold alcohol to and alcohol. and rapid drinking’. The show featured children, compared to 20 per cent last year and 50 per The authority has agreed that his report should be a scene in which two doctors drink cent in 2004. presented to both the Home Office’s drug policy consultation several shots of tequila in rapid Children were involved in test purchases over a ten and the forthcoming one from the Welsh Assembly succession – ‘it was also implied that week campaign targeting premises known to be Government. ‘It is hugely significant that the call for a legal their drinking would lead to a sexual problematic. However, less than one per cent of premises regulation and control of drugs has now been publicly encounter’ it says. ‘There are strict targeted by the campaign ‘persistently’ sold alcohol to supported by the North Wales Police Authority,’ said director controls on alcohol advertising and children, classed as on more than three occasions. of Transform Danny Kushlick. ‘There are many high profile marketing but the impact of these ‘These results show that the situation in relation to individuals who support this position but this sort of rules is being diluted by irresponsible underage sales has improved and the industry has played institutional support really puts the debate centre stage. programming,’ said Portman Group a major part in delivering this improvement,’ said ‘We hope to see other police authorities following their chief executive David Povey. Association of Chief Police Officers’ lead on alcohol, lead,’ he continued. ‘The government must now engage with Alcohol Concern looks at the influence deputy assistant commissioner Chris Allison. ‘However, the significant and growing body of mainstream opinion of TV advertising – this issue, page 10 underage sales still remain an issue and the industry calling for pragmatic moves away from prohibition towards needs to maintain its focus.’ evidence based regulatory alternatives.’

4| drinkanddrugsnews | 22 October 2007 www.drinkanddrugs.net News | Round-up

Floating pre-voters: around 80 children from London secondary News in Brief schools got a chance to put their questions about drugs to Home NTA updates clinical guidelines Office minister Vernon Coaker at a An updated version of the Drug special event on board HMS Belfast misuse and dependence – UK recently. They were asked to give guidelines for clinical management, their views on issues such as what widely known as the ‘orange book’, schools can do to prevent drug use, has been published by the National and what are the best forms of Treatment Agency for Substance support to help young people avoid Misuse (NTA). The evidence-based drugs. The event formed part of the guidelines, which update the 1999 government’s consultation on the version, reflect the changes in drug future of its drugs strategy. ‘We can treatment in that time as well as never be complacent about the current NICE guidance, and provide a scourge of illegal drugs and remain UK-wide framework for the clinical committed to tackling drug use treatment of drug misuse. Available at through education, enforcement and www.nta.nhs.uk/areas/Clinical_guidan treatment,’ said the minister. ce/clinical_guidelines/docs/clinical_gui delines_2007.pdf

Leicester links Middle class areas top Scottish drug-related New resources to help people in Leicestershire and Rutland get ‘hazardous drinking’ table deaths show big rise advice, information and support about drink and drugs issues have People living in the comparatively wealthy areas of England – The number of drug-related deaths reported by Scottish been launched by local DAATs. The predominantly in the south east – are the most likely to be police rose by 42 per cent, from 254 to 374, between 2005 campaign centres on a new website drinking at ‘hazardous’ levels, according to the new local and 2006 according to the National Programme on www.drugs.org.uk which provides authority alcohol profiles for England from the North West Substance Abuse Deaths’ (np-SAD) new annual report. details of local and national services, Public Health Observatory at Liverpool John Moore’s University. Overall deaths, however, for England, Wales, Scotland, as well as information for other Hazardous drinking was categorised as consuming the Isle of Man and Channel Islands were down by one per professionals and practitioners. The between 22 and 50 units of alcohol a week for men, and cent, from 1,382 to 1,366, for the same period. Deaths in site had been ‘developed to give between 15 and 35 a week for women. Those in the poorest Northern Ireland fell from 52 to 22. those who need and advice about areas, however, were the most likely to be drinking at More than three quarters of the deaths were males, drink and drugs an easy way to find ‘harmful’ levels – more than 50 units in a week. and the average age of death was 38. Most died either in out about the services that are The study found that the hazardous drinking hotspots their own home or a friend’s house, while 18 per cent died available to them,’ said co-ordinator included Waverley, Woking, Runnymede, Surrey Heath, in hospital and 8 per cent in a public place. Most deaths for Leicester DAAT, Kate Galoppi. Guildford, Mole Valley and Elmbridge – all had more than 25 were accidental poisonings involving opiates either alone or per cent of adults drinking at this level. Manchester topped in combination with other drugs. The highest number of Counselling cash the ‘harmful’ drinking table, however, followed by Liverpool, drug-related deaths per 100,000 population was recorded in People arrested for alcohol-related Salford, Knowsley, Rochdale, Tameside and Leeds, which also Blackpool and Fylde, at 19.4, followed by Brighton and Hove offences in Liverpool will be required figured in the ‘hazardous’ table. Across all local authorities, and Western Cumbria. to pay £30 towards the cost of their hazardous rates of drinking ranged from 14 to 26 per cent of Constant monitoring of drug-related deaths in Scotland counselling to help fund Alcohol adults, while harmful rates ranged from 3 to 8 per cent. was necessary to determine the reasons for the trends and Arrest Referral Projects (AARPs) in ‘While much attention has been paid to binge drinking, put measures in place to prevent avoidable deaths, said Ealing, Manchester, Liverpool and less discussion has focused on the damages associated with director of the International Centre for Drug Policy at St. Cheshire. Under the AARPs, people routinely consuming too much alcohol,’ said director of the George’s, University of London, Professor Hamid Ghodse. taken into custody are given advice North West Public Health Observatory, professor Mark Bellis. ‘Prevention of the loss of life at any age, especially of the by resident alcohol specialists about ‘Across England, around one in five adults are drinking young, due to the scourge of drug abuse has to be the alcohol issues. Some may then be enough to put their health at significant risk and one in 20 priority for any government,’ he said. referred to more advanced alcohol enough to make disease related to alcohol consumption Report available from St, George’s, University of London advice sessions, and failure to attend practically inevitable.’ at £15 email: [email protected] may result in prosecution for the original offence. The pilots will be used to assess whether brief Scotsmen twice as likely to use class As than women interventions reduce offending among those arrested for drink-related Scottish men were twice as drugs was highest among 20 found it ‘very easy’ or ‘fairly interviews with almost 5,000 offences. ‘People need to face up to likely to have taken one or to 34-year-olds, while use in easy’ to obtain drugs, while 38 people. Levels of lifetime and the damage that excessive drinking more class A drugs in the last the last year and last month per cent said they had taken current drug use were higher can do to themselves and those year than Scottish women, was highest in the 16 to 19 another drug while under the than before but the survey around them,’ said Home Office according to new figures. age group, and among those in influence of the drug they concluded that ‘methodolo- Minister Jacqui Smith. ‘These powers Drug misuse in Scotland: manual occupations, those used most regularly. Eighty per gical changes mean that it is will complement powers already findings from the 2006 Scottish who had never worked and cent had consumed alcohol not possible to make mean- available to the police to tackle crime and victimisation survey students. Eighty per cent of under the influence of drugs. ingful comparisons’. alcohol-related disorder.’ also found that lifetime use of current drug users said they The figures are based on At www.scotland.gov.uk www.drinkanddrugs.net 22 October 2007 | drinkanddrugsnews | 5 Cover story | Addiction and children

‘This is a rose, a multi-coloured rose. It floats about, it’s in a cloud. It doesn’t have any other flower friends, It floats about on its own.’ 10-year-old girl living with her mother in a residential rehab unit. Home truths This summer saw an exhibition in Glasgow of art created by the children of people with drug and alcohol problems about the impact their parents’ addictions had on them. The works on display were shocking, upsetting and often very moving. David Gilliver talks to one of the organisers.

‘My da, years and years ago, when I was a wee Marina Barnard of Glasgow University’s Centre for carers’ group – and where I knew a very high boy, left a packet of tic tacs sitting on the Drug Misuse Research saw the Kids Company’s proportion of kids came from families where table and told me not to touch them. I ate half Shrinking Childhoods exhibition at London’s Tate substance misuse was an issue. And this really is the packet and spewed up all night. My dad Modern a couple of years ago. ‘I thought why can’t a major problem in Scotland.’ said they were adult tic tacs.’ we do that in Scotland?’ she says. ‘I couldn’t think The exhibition had two main aims – that it was a These words accompany an art work of a doll of a good reason, so I immediately set about trying rewarding experience for the children but also got lying next to a mess of drug paraphernalia. Its to raise the funding.’ the message across about the impact of drugs and creator, now 16, is one of a number of children of ‘I’d done research on drugs and families over alcohol on their lives. ‘We made sure it was fun and parents with substance misuse issues whose the last seven years, but I’ve been a drugs that they wanted to do it,’ she says. ‘We weren’t works were exhibited in a groundbreaking exhibition researcher for about 20,’ she says. ‘We got in pushing them to a place they didn’t want to go to, Trying Childhoods, held this summer in Glasgow. contact with groups that I knew were working with but we were always up front that we were putting on The original impetus came when Professor kids – a church group, a voluntary group, a young an exhibition. We wanted it to be a strong voice to a

6| drinkanddrugsnews | 22 October 2007 www.drinkanddrugs.net Cover story | Addiction and children

largely unknowing public about what it was like to ‘They are expressive but incredibly restrictive, and Childhoods meant that it was a big hit with the live with drugs in such close proximity.’ doing anything else was very difficult for them.’ local press and media, but for Professor Barnard The centre engaged the services of artist and The project with the boys was supposed to last 11 and the other organisers the important thing was trained art therapist Liz Mitchell, and animator and weeks, but took a year. ‘Children take a long time to that it struck home with audiences. ‘The people illustrator Jana Prcalova. Nearly 80 children were open up. Over time Liz got them to make a represen- who came to see it were genuinely moved, and that involved in all, with ages ranging from as young as tation of their neighbourhood. It was a big map of the for me was its success. They were shocked and three to 18, working with media including painting, east end of Glasgow, with things like pharmacies and saddened, and I think you should feel sad that it’s drawing, video and animation. a big graveyard – a lot of people had died. The whole so hard for such a large number of children.’ ‘Some of the kids really leapt at the chance to landscape was littered with knives, violence, Some of the people who signed the comments do it,’ says Professor Barnard, ‘particularly in the prostitutes, needles and degradation, and underneath book described the emotional impact it had had be- better-supported groups where they’d done a lot of are their quotes about people who’ve died, and their cause of their own substance misuse issues. ‘People talking work, while some had no expectations at all. experiences with drugs. It was a real journey for who had lived with their own addiction were very It always had to be safe – we couldn’t say to them them, and it’s a very powerful representation because moved by it,’ she says. ‘Seeing the work of children “you’ve got to represent your mum or your dad” or kids often think in very clear black and white terms.’ and their description of that pain is a useful thera- something like that, because part of the burden for The exhibition is now in storage, but will soon peutic tool. One of the reasons people come out of them is that people are always pointing the finger. be transferred to the Scottish Parliament, where it’s addiction is because of their children, and this helps ‘For a child living around drug or alcohol addiction being sponsored by former justice minister Cathy reinforce that – when you’re in addiction all you see is it’s a very secretive world they inhabit,’ she continues. Jamieson MSP, and there has been widespread your own preoccupations. When you come out of it ‘They can’t tell others because of the shame and the interest from other organisations, both in the UK you see the costs to the people you love, so I think fear that it might lead to them being taken away from and overseas. ‘It’s a fantastic lobbying opportunity used in a safe way it’s a vehicle for helping people their parents. Even if things are really bad, that’s the because it speaks a fairly powerful language about understand the price children pay and the importance reality they know and to be taken out of that into the impact of drugs on families and communities,’ of providing another kind of life from them.’ another circumstance is terrifying.’ says Professor Barnard. ‘I think it’s a very powerful statement and an imp- The university put up half the money, and A separate launch was held for the children the ortant resource,’ she says. ‘It has therapeutic value, fundraising brought in the rest. ‘When I think back day before the exhibition opened to the public to it has scope to really move things on, and I think it on it was completely mad at one level because we maintain their anonymity. ‘Some really wanted their speaks a language that bureaucracy can’t. Hidden had no idea whether we’d produce anything that names on it but we thought it was best to keep it Harm talks about 350,000 kids in this situation but we’d be even be able to exhibit,’ she says. anonymous because it’s a sensitive issue,’ she ultimately it’s just a number – you see a representa- One of the most striking pieces in the exhibition says. ‘They were very proud of what they did – one tion of a child’s pain and it has another impact. I do was the work of a group of six boys who were girl was so moved that her picture was there that think you have to connect with these issues emotion- involved in local graffiti and gang culture. ‘When Liz, she cried. They liked the idea that other people ally, otherwise what hope do these children have? the art therapist, started to work with them all they were going to know. We didn’t set out for it to be There were three or four different pictures where could produce, week after week, were ‘menchies’ therapeutic but I think it was.’ children had written the word “help” – it’s a strong [stylised graffiti signatures],’ says Professor Barnard. The powerful and striking nature of Trying statement about living with the burden of all this.’

www.drinkanddrugs.net 22 October 2007 | drinkanddrugsnews | 7 Conference news | Image-enhancing drugs

Getting through to the body beautifuls David Gilliver reports from the conference Performance and image- enhancing drugs in the 21st Century in Liverpool earlier this month.

Doctors must engage checks on PIED users, including heart, ECG and know and understand gym culture because it’s The role of GPs in providing care for users of testosterone levels, he said. such a closed world,’ he said. performance and image-enhancing drugs (PIEDs) Use of PIEDs could cause all kinds of problems, Staff didn’t necessarily need first-hand was one of ‘damned if you do, and damned if you ranging from acne to hypertension, cardiovascular experience of PIED use, he said, A knowledge of don’t’, according to medical officer at Drugs in problems, infertility, musculoskeletal disorders, harm reduction was more important. Sport Clinic and User’s Support (DISCUS), Rob aggression, paranoia and liver damage, he said. PIED users were a hard-to-reach group, but Dawson. ‘You’re damned if you do get involved and There were also the dangers associated with the persistence paid off, he said. ‘It’s about going out damned if you don’t – but doctors should be large number of counterfeit drugs on sale, and the there and being bold and approaching people like damned if they don’t’ he told delegates. risks associated with injection, such as abscesses, gym owners. Word of mouth is very important – More than 40 per cent of patients accessing HIV and hepatitis. eventually clients will come to you, when you’ve needle exchanges in the North East of England ‘PIEDs are not safe and nobody should use built up trust.’ Use of peer education and needle were now anabolic steroid users rather than heroin them,’ he said, ‘but we still need more evidence. If exchange records was also vital, he said. users, he said, but even these figures were likely to the evidence isn’t there, then we can’t moralise. Barriers to the work included a lack of time as drastically underestimate the scale of the problem. Education is the key. PIED users are as entitled to the client group was increasing, ever more drugs ‘Many of them will be collecting for others – a gym our services as anyone else and we must encourage coming on to the market and issues of politics. owner might be collecting for 200 people so the them to come forward.’ ‘Some people question whether we should even be figures are wildly inaccurate. It’s the tip of the doing this work,’ he said. ‘There’s a school of iceberg – but it wasn’t the tip of the iceberg that PIED use becoming ‘normalised’ thought that says you should concentrate on the sank the Titanic, it was what was underneath.’ The use of performance and image enhancing class As, people in the sex industry, gay men. But at Users could be split into four main groups, he drugs was becoming ‘normalised’ in parts of the the end of the day, PIED users are injecting drug said. The first was people seriously involved in south Asian community, outreach worker for West users, and a very large proportion are also using sport, where it was essential to gain their trust and Yorkshire-based voluntary drug and alcohol agency cocaine, for example. We need to keep it on the show the damage that could be caused. The second Project 6, Naveed Khan, told the conference. ‘It’s political agenda.’ was those who had recently become involved in seen as normal and legal, not something that’s sport, and perhaps intended to use PIEDs as ‘a “dirty” like heroin,’ he said. Image pressure drives gay shortcut to the body beautiful.’ With them, GPs Needle exchange records showed an explosion men to steroid use should explore their rationale and offer of PIED use in the areas covered by Project 6, he Around ten per cent of gay men attending gyms in alternatives like diet, he said. said. ‘It was between five and six per cent a few the London area were steroid users, according to The third main group was occupational users years ago – now it’s 25 per cent. There is a definite substance misuse worker Roy Jones from Turning like doormen, police and prison warders who often failure of services to provide specific provision for Point’s Hungerford Drug Project. ‘There are felt they were using them to help society and PIED users.’ transmission risks around HIV and hepatitis B and didn’t want to feel penalised, he said. ‘I always Users were attracted by the fact that the drugs C but many of the people we work with are advise not to use at all, but this is often met with a were cheap and the gains were almost reluctant to go into drug services because they wry smile’. The last was recreational users, who immediately noticeable, he said, and use was not don’t see themselves as drug users,’ he said. used the drugs to enhance aggression and stamina contained in one age group, with some users under The project had launched the Steroid Users’ and foster a sense of wellbeing and were the 16, and many were using very high doses. ‘People Support Service (SUSSED) in association with hardest to reach because they could not be will just jump start and use all the substances at CLASH (Central London Action on Street Health) the accessed through gyms, he said. once,’ he said. outreach service of Camden PCT. Their main client The rationale of getting involved from a medical Better delivery of drugs education targeting group was gay men in their 30s with disposable point of view was one of harm minimisation, he PIED use was essential, he stressed, as the available income, he said, and around 25 per cent were HIV+. said. ‘Some athletes have even said they are literature was sparse and much of it jargon-heavy. The service taught safer injecting techniques, and prepared to die, so how do you influence their Harm reduction interventions on the streets were promoted itself through word of mouth and behaviour? They will try anything – they are also vital, as were referrals to primary care and editorials in the gay press. ‘When we started only literally their own chemical testing units.’ continuous monitoring of data. ‘There’s no middle one gym would allow us any access,’ he said. It was extremely unusual to just use one drug, he ground with steroid use, so it’s about harm Among his client group, PIED use was almost said, and admitted there were almost certainly reduction,’ he said. ‘They’re always going to use, so exclusively for image reasons. ‘It’s all about the way drugs the medical establishment was unaware of. you have to encourage them to use lower doses.’ you look,’ he said. ‘It’s a quick, affordable route to Injection was safer with some PIEDs because it was bigger muscles.’ Some of his clients were commercial less damaging to the liver. ‘We need to be engaging Understand the culture sex workers who used PIEDS to attract customers, in a two way dialogue,’ he said. ‘It’s vitally important It was essential to understand gym culture when and there was intense pressure in gay club culture to that they have access to safe injecting equipment, doing proactive outreach work around PIED use, look good: ‘It’s all about tops off and “disco tits” – if and we need to show them injection techniques and manager of North Surrey PCT’s health promotion you don’t fit into that group you can feel very injection sites.’ GPs should also be doing full health outreach team told delegates. ‘You need staff who marginalised – especially if you’re young.’

8| drinkanddrugsnews | 22 October 2007 www.drinkanddrugs.net Letters | Notes from the Alliance

On my radio Inadequate response

Like many people, we were horrified by the Your coverage of the Addictions Report in recent Radio 4 Today interviews on treatment. Breakthrough Britain (DDN, 16 July, page 4 – Notes from the Alliance Here are just a small number of our serious ‘Flying in the face of evidence: agencies attack concerns. Tory drug proposals) was disappointing. Starting 1. In response to the stern challenge of John with the title, it was misleading and inaccurate Talking to the hand Humphries concerning the nature of treatment, on a number of counts. It was, furthermore, a Are you really listening, the minister stated that ‘these are people who very thin response to a very thick report. are actually in treatment receiving support, This was one of the most researched and Daren Garratt asks the counselling and proper direction’. Maybe we wide-ranging inquiries into drugs and alcohol Home Office – or is the drug should have an independent study that reveals policy ever conducted. It was our second and strategy consultation a what proportion of people in treatment receive final report. In our 18-month process we took foregone conclusion? counselling by trained counsellors – and how evidence from over 50 organisations and over much they get – to test the veracity of the 100 individuals; we researched and reviewed I’m writing this column the day before the closing date for minister’s statement? We know few people in all relevant Home Office and DoH research submissions to the Home Office’s Drug Strategy Consultation exercise and The Alliance, like many partner organisations, have treatment who get proper counselling, but many reports, the NTA’s own investigations and had conflicting feelings about the whole process. say, ‘alongside my methadone I get 20 minutes independent academic research projects, Has this been a genuine attempt to listen to the views of all a fortnight with my keyworker’. including NTORS and DORIS. We produced stakeholders and interested parties and shape a pragmatic, robust 2. The minister stated that we are having seven research briefings to the first report – and effective drug policy that responds appropriately to complex more success than anywhere else in Europe. ranging from the residential rehab beds and wide-ranging, physical, mental and socio-economic issues, or a How can she make this statement when long- referral crisis, to a full analysis of capacity of cynical, tokenistic attempt to placate us into believing we’re actually term outcomes are not measured? (As an treatment and efficiency, to a critique of the being listened to when final decisions have actually been made? aside, DDN should send her a copy of Neil government’s Supply Reduction Strategy. Personally I suspect the latter, but as a national user-led McKeganey’s article in last issue.) Research briefings for our second and final organisation that has sought this level of consultation for many 3. The first piece of evidence the minister publication included a full review of prison treat- years we have simply had to engage, regardless of how flawed, provided about the effectiveness of treatment ment services and a comparative analysis of lopsided and dismissive of the role of users this process has was that it is reducing crime – rather than say- policy implementation in Holland and Sweden. appeared to be. ing more people are reducing or overcoming We published detailed evidence from Alcohol For instance, although the consultation paper does their drug use problems. Sadly, this is a Concern and the Institute of Alcohol Studies, acknowledge that ‘Users and carers play a vital role in helping reflection of the political agenda that drives especially researched and prepared for us. drug users remain in treatment and reintegrate into society as the treatment system. Where and how our proposals fly in the face their treatment progresses’, the consultation process provides no 4. One of the major reasons that the of the evidence mystifies us. Unfortunately you question about the importance of the role and how we should be treatment industry in the US collapsed did not elucidate. Rather, your news report integrated into future developments, and merely asks if there is ‘a (1980s-1990s) was that it over-promised what seemed to rely entirely on the opinions of two place for role models, including those drawn from peer groups, in it could achieve. The industry eventually got lobbies who simply appear to dislike our empha- drug information campaigns?’ This is a classic example of non-inclusive consultation; the caught out. Sadly, we in the UK are making the sis on abstinence-oriented treatment – perhaps type of consultation that merely asks you to comment on a series same mistake in over-promising (‘Treatment because it does not fit in with their ideologies or of closed questions relating to predetermined ideas as opposed to Works’) and potentially setting clients up for moral positions? They do not seem to have any a non-directed, blank-sheet approach that simply asks, ‘what failure. We need to think beyond treatment, evidence-based reasons for decrying it (or at works?’ Although, that said, we could only really identify ‘what and focus on recovery and the role that least these are not argued in your report). This works’ if we had a comprehensive audit/review of the last treatment can play. We must take a long is obviously controversial territory but we have strategy, but that’s a different argument for a different day… serious look at how our treatment system is set out the evidence-based reasons for So we submitted a response, but we refused to answer their managed and operates. It is time that we asserting that it's important. questions. Instead, we felt we that we could best represent the stopped thinking about treatment for You ignored entirely the crisis of care we needs of our constituency by both engaging with the consultation treatment’s sake and focus on what we should highlighted with regard to the prison population, process in order to suggest recommendations (particularly with really be doing – helping people achieve long- families and children and our positive proposals regards to treatment options, harm reduction and public health) term recovery, using treatment as only one to address this. Furthermore you allowed a and highlight concerns, by writing a critique of the process, important way of enabling people do this. completely inaccurate representation of our highlighting its failings, illegitimacy and how it doesn't respond to 5. Key factors underlying recovery are public health policy proposals concerning or reflect users needs, while simultaneously making the criticisms support and acceptance in society. Social inter alia needle exchanges and viral testing we have of that process public where necessary. stigma is harmful to recovery, but the reporter without checking what we said or noting that Time will tell how effective this whole process will ultimately was allowed to get away with using the they were squarely based on concerns already prove to be, but if we feel that our views have not been socially isolating and stigmatising label raised by the NTA on quality and practice failure. considered, or that a strategy already exists as a fait accompli, ‘junkie’ without being challenged by a leader DDN owes it to itself to give our report and then we'll respond to that in an appropriate way, at an in the field. the issues highlighted more informed and appropriate time. Policy consultation should not be a time- limited, stand alone event; it should be an ongoing process of PS What an excellent article by Neil enlightened coverage. Perhaps you would like monitoring, evaluation and review. McKeganey on San Partignano, a truly to give us an opportunity to respond? So if any users out there do have concerns about existing extraordinary place (DDN, 24 September, The Addictions Working Group: Kathy Gyngell government policy, the consultation process or the new strategy, page 6). It shows what can be achieved in this (chair), David Burrowes MP, Professor Chris the Alliance/DDN User Conference ‘Nothing about us without us’ field with a thoughtful and caring nature, and Cook, David Partington. Andy Horwood in Birmingham on 31 January could be the ideal opportunity to the right application. We, in this country, need raise them directly with the Home Office itself. to take note and act! Ed’s note: Our news report was a round-up of PS Thanks to Peter Mc Dermott for drafting the Alliance’s Professor David Clark, director of WIRED reactions to ‘Breakthrough Britain’, not analysis of response and general spiritual guidance. and Lucie James, WIRED its content, and opinions were those of agencies Daren Garratt is executive director of the Alliance (See Prof Clark’s recovery article on page 15.) quoted. We have invited an article from the group.

www.drinkanddrugs.net 22 October 2007 | drinkanddrugsnews | 9 Alcohol | Advertising to children

Not in front of the children The government’s updated alcohol strategy, Safe, Sensible, Social aims to reduce the number of under-18s who drink and the amount they drink. But Alcohol Concern found that many children are being openly influenced by alcohol advertising during their favourite programmes, as Don Shenker explains.

lcohol Concern decided to investigate way as adults. The authors concluded: ‘In The Advertising Standards Authority the extent to which children were essence, the more aware, familiar and scheduling and the Committee of Advertising being exposed to alcohol advertising, appreciative young people are of alcohol the Practice (Broadcasting) rules dictate that no A by looking at the scheduling of more likely they are to drink both now and in alcohol adverts should be shown during alcohol adverts. In particular, we wanted to the future.’ programmes ‘particularly likely to appeal’ to see the extent to which they appear on The World Health Organisation's European audiences below the age of 18. A programme television before and after the 9pm watershed Charter on Alcohol states that: ‘All children is considered to be of particular appeal to and whether any of them are placed within and adolescents have the right to grow up in children if the proportion of children watching programmes aimed at children. We were also an environment protected from the negative is 20 per cent greater than the proportion of keen to look at whether the current rules on consequences of alcohol consumption and, to children in society – a very high threshold. the scheduling of adverts are adequate. the extent possible, from the promotion of The Committee of Advertising Practice Our investigation focused on two separate alcoholic beverages. A long-term national rules for non-broadcast advertising state that weeks of broadcasting, looking at when alcohol study in the US, published in January 2006, ‘no medium should be used to advertise adverts appeared and within which TV program- concluded that for each additional dollar per alcoholic drinks if more than 25 per cent of its mes. A small sample of individual programmes capita spent on alcohol advertising in a local audience is under 18 years of age’ – a much were then analysed for demographic break- market, young people drank 3 per cent more. lower threshold. downs to see the percentage of children view- Research on young people’s alcohol It is unclear why non-broadcast rules are ing at the time. We found that most alcohol consumption rates carried out last year different to broadcasting ones. But this means adverts actually appear before the 9pm showed a marginal decrease in the numbers that an alcoholic drinks advert scheduled on watershed and in programmes where large of young people who had consumed alcohol in television has fewer restrictions in relation to numbers of children are viewers. the past week. However children who do protecting children than if the same advert Previous studies have shown that young consume alcohol are now drinking more units was placed in a tube or railway station. people are increasingly adept at interpreting than previously. Alcohol Concern’s Glass Half Alcohol Concern carried out unique the cultural messages contained in alcohol Empty report showed 11- to 13-year-old boys research into alcohol adverts in two separate advertisements. Research on alcohol advertis- drinking 43 per cent more units in 2006 than weeks (11 to 17 December 2006 and 19 to ing among 10- to 17-year-olds, conducted by they did in 2000, and 11- to 13-year-old girls 25 March 2007) to see how many alcohol Strathclyde University in 1988, indicated that drinking 82 per cent more units. adverts featured before the 9pm watershed, 88 per cent of 10- to 13-year-olds and 96 per Looking at the broadcasting and regulatory and which TV programmes these were placed cent of 14- to 17-year-olds were aware of framework for advertising highlights areas of during. We also looked at the age breakdown alcohol advertising and 76 per cent of these inconsistency and confusion. Ofcom’s own of a small sample of programmes potentially could identify three or more advertisements research carried out in 2004 around alcohol aimed at, or attractive to, children. when the brand name was masked. advertising and its impact on children declar- We looked at the distribution of alcohol Four years later, it was shown that young ed much television alcohol advertising (of adverts before and after the 9pm watershed in people, even 10- to 12-year-olds were adept at alcopops in particular) to be ‘closely aligned a seven-day period in December 2006. Our interpreting the messages, images and target- to youth culture and of strong interest to study showed the majority of alcohol adverts ing of alcohol advertisements, in the same underage drinkers’. were shown before the 9pm watershed. There

10 | drinkanddrugsnews | 22 October 2007 www.drinkanddrugs.net Alcohol | Advertising to children

Advertiser Alcohol Product Channel Time and Date Programme Total (number of 4-19 yr-olds watching)

William Morrison’s Special Offer: Five 6.13pm Home and Away 6,000 (regional figure for (supermarket) Grolsch 2-pack 11 December 2006 just ITV West viewers)

Lidl (supermarket) Fine Wines & ITV 7.46pm Coronation Street 237,300 ‘Low Prices 3’ 15 December 2006

William Morrison’s Special Offer: ITV 1.53pm The X Factor – 1,126,000 (supermarket) Grolsch 2-pack 17 December 2006 The Final

were also twice as many supermarket alcohol complicated, it also means that hundreds of from alcohol advertising. adverts shown before the watershed than after. thousands of children are regularly being G In programmes which run after the There was also a rising number of alcohol exposed to alcohol advertising in this country. watershed but are still likely to appeal to adverts shown from 3pm to 5pm, coinciding The Advertising Standards Authority is some children, such as sporting events, with the time when most children return from responsible for dealing with public complaints alcohol adverts should not appear where school. It would be a reasonable assumption about advertising but the system used for more than 10 per cent (one in ten) of the that most people in employment will not have assessing whether a programme is suitable audience are, or are likely to be, children. returned home until after 5pm, so the marked for alcohol advertising is complex and not G The regulations covering alcohol adverts spike in alcohol advertising between 3pm and well publicised, and this makes it difficult for should state clearly who is responsible for 5pm is, at the very least, puzzling. the public to complain. monitoring scheduling and what sanctions Alcohol adverts were shown during a It is not clear why the Committee for exist when these are contravened. This number of programmes where a significant Advertising Practice’s non-broadcasting information should be publicly promoted. share of the audience included children, regulations, stating that alcohol adverts G Inconsistencies between the CAP non- including Home and Away and The X-Factor. should not be shown where under-18s make broadcast and broadcast codes should be In some popular soap programmes such up more than 25 per cent of the audience, resolved, with a clear definition of as Coronation Street, there are likely to be are different from the broadcasting regula- programming likely to appear to children more than one million children watching the tions concerned with programmes ‘likely to identified and promoted. programme. Although the programme may not appeal to under 18s’. It could be argued that be judged as likely to appeal to children, the all of the programmes analysed by Alcohol Our research highlights how easy it is for large numbers of children viewing is of great Concern are likely to appeal to under-18s. drinks advertisers to show alcohol adverts concern. At the time of our study, 11 per cent In spite of various codes and regulations, during the times that children are more likely of the audience was shown to be between alcohol adverts are appearing in programmes to be at home, watching TV, and during four and 19 years old – representing that appeal to large numbers of children and programmes that appeal to them. We need to 1,126,000 young people. where the total number of under 18-year-olds explore how we can do more to protect Supermarket advertising appears to parti- watching is significant. children from alcohol harms and promote a cularly aim to reach early evening audiences, In light of our findings, Alcohol Concern safer, more responsible culture in relation to with double the amount of supermarket has made the following recommendations: young people and alcohol. alcohol adverts appearing before 9pm. Similarly, The X Factor and Home and Away G There should be no alcohol advertising This subject will be explored at Alcohol are clearly programmes viewed by children and (either branded or supermarket) from 6am Concern’s conference ‘Too Much Too Young’ on likely to appeal to a young audience. The 20 through to 9pm regardless of the 7 November in London. See per cent rule, which says that programmes are predicted age of audience of a www.alcoholconcern.org.uk for more deemed to be unsuitable for carrying alcohol programme. In other words, there should information on the conference and AC’s report. advertising if the proportion of children watch- be no alcohol advertising before the ing is 20 per cent greater than the proportion watershed. In our view this is the only Don Shenker is director of policy and of children in society, is not only unnecessarily sure way to protect the majority of children services at Alcohol Concern

www.drinkanddrugs.net 22 October 2007 | drinkanddrugsnews | 11 Public health | Needle exchanges

What’s the point of needle exchange?

eedle exchange programmes (NEPs) have NEPs have caused a great deal of controversy. Those introduction of a high volume NEP area. A study in been described as the most visible who want to stress their advantages will cite 1999 showed no benefit of NEP attendance upon component of harm reduction. They permit overwhelming research evidence that NEPs work from incidence rates of HBV and HCV among IDUs in Nthose who inject drugs to exchange a harm reduction point of view. Some who stress the Seattle. In Montreal, a 1977 study showed that potentially contaminated syringes and other works, disadvantages will refer to a small number of key there were higher HIV incidence rates among NEP for sterile ones. Besides syringes, clean water, citric studies that say NEPs do not work and may even attendees compared to non-attendees. However, acid, tourniquets, and other works may be offered, increase the spread of blood borne viruses. However, these findings seem to contradict the many studies and there are often staff on hand to offer literature those against NEPs more often argue that these between 1995 and 2003 that have shown that and advice on wider harm reduction issues relating programmes are wrong from a moral and ethical NEPs do achieve their primary goal in reductions of to substances and sexual health. viewpoint. Evaluating the evidence relating to NEPs incidence of HIV, HBV and HCV infections. A decade First introduced in Amsterdam in 1984, NEPs were indicates that they are necessary for public health ago, a comparison between 29 cities with a response to the public health threat of HIV/AIDS. reasons, and are in fact ethically sound. established NEPs, showed they decreased HIV This virus was increasingly found in injecting drug One argument against NEPs suggests that easy prevalence dramatically – by 5.8 per users (IDUs), being spread through the sharing of availability of sterile equipment could assist the cent a year on average, compared contaminated works and to their partners through transition to injecting and encourage earlier onset of to an increase in HIV of 5.9 per sexual transmission. In the USA in the mid 1990s, this practice. This is clearly a risk, although cent in 51 cities without injecting drug use accounted for nearly half of new anecdotally, I would have to say from experience of NEPs. A New York City HIV infections, clearly demonstrating the need to working with IDUs and other drug users, this does not study backed up the fact prevent an epidemic. NEPs are also a response to seem to be the case. Injecting drug use is still that NEPs were the threat of other viruses spread through blood frowned upon among many drug users. Most who associated with a borne pathogens such as hepatitis B and C, and progress to injecting do so because smoking heroin dramatic decline human T cell lymphotropic viruses, as well as simply does not have the same effect any more in HIV addressing wider problems caused through sharing because their tolerance has increased, and so incidence, and reuse of the same needles, such as increased injecting is a matter of need not desire. And far from risk of endocarditis, cellulites and abscesses. NEPs encouraging the use of injecting, the reverse may be true. An Amsterdam study showed a decline in injecting among those involved in NEP programmes. Some say that needle exchanges do not achieve and their goal of harm reduction and there have been further some studies that suggest this is the case. research An HIV outbreak among IDUs in has shown Vancouver in 1997 that NEPs were followed the effective in reducing risky behaviours such as needle sharing. So, what are we to make of the mixed evidence? Selection bias has been suggested as an explanation: those who obtain syringes from other sources could have accounted for the higher HIV incidence observed among

12 | drinkanddrugsnews | 22 October 2007 www.drinkanddrugs.net Public health | Needle exchanges

From an ethical point of view, the numbers of needles found discarded in the Are needle exchange practitioners may not want to feel street following the establishment of a NEP; that they are condoning drug use by another study showed that the overall worldwide programmes worth the giving out needles. If your ethical return rate for needles was 90 per cent. viewpoint comes from a belief that drug Clearly abstinence is the best approach to controversy they attract? use is a moral and criminal problem and is eliminating problems relating to drug use, as many therefore wrong, as is often the case in the opponents of the harm reduction approach point Justin Dunne finds USA, then it will be hard to support NEPs because out. But this is quite simply not a realistic goal. you will be drawn towards a zero tolerance Even with the best public health campaigns there evidence to support abstinence-based approach. In the USA this has will always be those who choose to use been reflected in policy, which means that no substances. This is especially true of adolescents their contribution federal money can be given to NEPs and in some who are going through a time when they are states they have become illegal. However, if you arriving at their own beliefs and values, where to public health. believe that drug use is a health or social problem, experimentation is perfectly normal, and where then your approach is likely to be one of trying to telling them to ‘just say no’ is likely to have the help people work through these issues with help reverse effect. We will never live in an abstinent and support. world and so we must deal with this reality and the The reality is that drug use will always be there, dangers it poses. NEPs have been cited as a and while there is a health threat to drug users, major reason why the UK has averted an HIV frequent versus there will be a health threat to their partners and epidemic among IDUs, so are a practical response infrequent NEP attendees in children. Failure to provide treatment and care to a less than ideal situation. Although most of us Vancouver. means that those innocent of any crime or would like to live in a world devoid of injecting drug Clean equipment may provide wrongdoing can become casualties of drug use, so use, this is a utopian dream. less of an incentive for people to reducing this risk is surely the morally right thing We must recognise that any injecting, even with give up injecting as some of the to try and achieve. clean equipment, carries inherent risks. Bad risks are reduced or removed. This However, the argument about protecting health technique will cause damage to veins and increase could lead to an increasing number is not as simple as it might first appear. Even if the risk of conditions such as deep vein of injectors being reliant on heroin and you believe in the health benefits of NEPs and thrombosis. Quite simply, frequent injecting is not on the crime associated with this to pay other treatment, there are always going to be a good health option and a scheme that for their habit, which obviously is not a limited resources available in a free healthcare encourages this has to be ethically questionable. good thing for wider society. Although this system like the NHS. Should the NHS be spending However, good injecting technique can be taught to theory sounds plausible, the reality is that large sums of money on IDUs, at the cost of other minimise risk, and engagement with IDUs is far NEPs give practitioners an opportunity to engage medical procedures on people who have not made more likely to result in treatment and the end of with drug users, and research shows that this choices that have put them at harm? This is a injecting use. Keeping people as safe as possible increases the rate of entry into drug treatment difficult argument, as we would need to follow it in the meantime must be a sensible option even if programmes. So far from encouraging people to through for people who drink, smoke, eat too it does have an element of risk. engage in and continue in their drug use, NEPs lead much or take too little exercise. Where do you Weighing up the evidence, my only conclusion is to a reduction. Because of this, it has been draw the line? that the use of NEPs worldwide should be suggested that NEPs should offer incentives such as It has been argued that NEPs may be justified encouraged and expanded. By 2000, there were financial reward to encourage attendance and to be on economical grounds if drug users are predicted 134 regions in the world with injecting drug use, involved in vaccination programmes – an initiative to have a reduced chance of contracting, and 114 of which reported HIV among IDUs. Sadly only that has been shown to treble attendance rates. needing expensive therapy for, hepatitis and AIDS. 46 of these regions had NEPs. Although this It is argued that NEPs will increase crime in the One study demonstrated that every HIV infection number has grown, there are still not enough to areas in which they are located, but a study on trends averted saved $20,947, showing clearly that a meet the worldwide need. Unfortunately, even carried out in 2000 showed that they do not. Research prevention agenda through harm reduction is a far where they do exist, uptake is not as good as it the following year demonstrated that there is no better option than long-term treatment. could be, with some studies showing that up to 80 association between living close to NEPs and reported Another anti-NEP argument put forward is that per cent of IDUs reuse syringes and share violence; nor were people living close by more likely to that giving out more needles will lead to more needles, even when NEPs are available. be robbed. The simple fact remains, whether people being discarded on our streets and the possibility With such overwhelming evidence for the recognise it or not, that drug users live among the of needle stick injuries to members of the public, effectiveness of NEPs, we need to look at the idea community already and the presence of an NEP there who could contract blood borne viruses. Inevitably of incentives to increase use as well as is not likely to change their current activity – apart there have been isolated accounts of needle stick encouraging IDUs to be involved in vaccination from positively, if they choose to engage. injuries occurring in cities with NEPs – but you can programmes. The high cost of treatment for Researchers have pointed out that sharing also find similar incidents where NEPs don’t exist. HIV/AIDS further justifies this approach. equipment is associated with socialisation in drug And because NEPs encourage less needle-sharing, Although there will always be moral objection to sub-culture, so some users will always continue to any needle stick injury that does occur is less anything that is seen to support drug use, NEPs share, regardless of the hazards. Although this is likely to be from a needle contaminated with a are necessary for public health reasons and are true, it is not a reason to deprive those who do want blood borne virus. more likely to lead to the reduction of injecting use to take note of the risks. Some people will always Far from the picture of IDUs being irresponsible through effective engagement, rather than by make risky choices, but others will engage with morally corrupt people who simply discard needles telling people they are wrong and should stop. services if they are available, and studies clearly anywhere, they have been shown to behave show that NEPs do not contribute to the formation extremely responsibly within these programmes. Justin Dunne is senior lecturer in public services of high-risk needle sharing networks. One study demonstrated a significant decrease in at the University of Gloucestershire.

www.drinkanddrugs.net 22 October 2007 | drinkanddrugsnews | 13 Understanding diversity | crack cocaine services

Cleverly-written diversity policies will not connect black crack users with services. We need to look at fundamental culture change to make services relevant, says Chris Robin. Beyond the crack

n the past the term ‘diversity’ was rarely heard. person because of their difference. The reality the existence of the black crack cocaine user? There was however, regular mention of the however, is often that the established culture of the G Why does our society demonise ‘crack’ when it Iinadequacies of services in meeting the needs organisation pervades by being perpetuated through is in fact a smokeable form of cocaine – a drug of possibly the largest minority population – people its workforce. This allows the black client, whether in that has for many years been acceptable in of African Caribbean descent. Today the term the service in a voluntarily or compulsory capacity, to white middle class and entertainment circles? (A ‘diversity’ is understood to refer to all cultural conclude that services are not designed to drug test that is positive for crack is still groups and aspects of their difference including understand or meet their basic needs. identified as ‘cocaine’!) sexuality and gender identity, religion, age, This is exemplified in the case of the black G Why do we continue to view working with crack education and status. What then has become of crack cocaine user who is most likely to have initial users as ‘difficult’? Are the needs of crack that defining group that spearheaded the movement contact with drug services through either the users different? Of course they are – inasmuch that drew attention to ‘difference’? mental health or criminal justice systems. as the needs of every individual client are Many people from African Caribbean descent To change this trend we must look not only at different, irrespective of their difference. If we currently feel that their needs have been forgotten. cleverly written policies, at training workers in keep working in the same old way, we will Those that are drug users are more likely to be diversity or lobbying senior managers. We must continue to make the same mistakes. offered help in the context of the prison system. take a critical look at how services have been Black people are overly represented in mental established and how their culture is perpetuated. The way forward has to be for us to take action to health institutions and are still more likely to be We must ask who is not accessing services and change the experience of the black crack cocaine stopped and searched, be refused bail and receive ask them why. We must be prepared to challenge user. Simply creating policies, training workers in a custodial sentence than their white, or other, the status quo. We must explore the research and ‘diversity’ or adjusting our services to work with counterparts. ask why so little has taken place within the black polydrug users, does not do this. Nor is it done by The concept of ‘diversity’ suggests that these community. We must look for answers to why black predominately providing drug services to black inequalities are identified and addressed. Is this crack users are not accessing services and we people once they are already caught up in the the case or does the term simply support the legal must effect change now! In doing so, we might criminal justice or mental health systems. For this frameworks provided by the Sexual Discrimination consider the following questions: we need to consult and engage with the black Act, the Disability Discrimination Act and the Race G Do we meet ‘difference’ in an open and honest community and involve them in the development of Relations Act? way with a commitment to meeting the needs of services that are specifically designed for black These pieces of legislation have been designed in that person in a real way, or do we meet drug users in order to provide them with real part to ensure that public services and professional ‘diversity’ as a paper exercise with a tick box choices in their lives. bodies no longer fail marginalised people. Those answer that enables us to cover our backs? organisations are required by law to ensure that all G In the 20 or 30 years that drug services have Chris Robin is training director at Janus Solutions. policies and strategies incorporate their intent to existed, are they still primarily geared towards For information on training visit address issues of diversity so as not to exclude any white opiate or polydrug users, thereby denying www.janussolutions.co.uk

14 | drinkanddrugsnews | 22 October 2007 www.drinkanddrugs.net Background briefing | Professor David Clark

Recovery and communities of recovery (part II)

Professor David Clark of Wired looks at recovery and treatment.

William White is author of one of the truly great who have been using heroin. books in this field, Slaying the Dragon: The History However, a very significant proportion of people of Addiction Treatment and Recovery in America. who access treatment want much more. They want He points out that there have been three organ- to resolve their substance use problems ising paradigms over the past 200 years to try and permanently and go on to lead meaningful and deal with the problems caused by drugs and alcohol fulfilling lives free of the substances that have in the US. Pathology, whether religiously or medically caused their problems. On the basis of the conceived, provided an organising framework from definition below, they want recovery: the late 18th Century through to the era of alcohol Recovery is the process through which severe prohibition. This paradigm fuelled a debate as to alcohol and other drug problems are resolved in whether alcoholism was a sin or a sickness. tandem with the development of improved physical, The pathology paradigm was replaced by the emotional, ontological (spirituality, life meaning), intervention model, which ‘buttresses multi-billion relational and occupational health. [My adaptation dollar industries aimed at preventing drug use, of definition from White and Kurtz, 2005] controlling drug supplies, punishing drug offenders, Many of these clients have a variety of other life and treating those with severe AOD [drug and issues – some caused by the substance use problem, alcohol] problems’. It is assumed that investigations others that preceded it – which they need help from into the etiology and patterns of substance use professionals in resolving. problems and studies of the professional treatment But is there sufficient help for those people who of these problems will reveal the ultimate solution want to find recovery? And, are we getting carried to these problems. away by the concept of treatment – and treating This model has generated significant new the symptoms, not underlying problems – to the understandings that sparked calls to bridge the gap exclusion of not understanding recovery (the real between research and practice in addiction end-point) and helping people achieve it? treatment. ‘Treatment is a tool, The resolution of substance use problems, or However, White and Kurtz point out that there recovery, is something that ultimately comes from has also been a disillusionment with this model albeit a valuable one within the person. Treatment is a time-limited, because of the intractability of substance use circumscribed experience or set of experiences that problems at a societal level, resulting in a shift in for many people, not an helps this self-change process. Treatment is a tool, focus to a third paradigm, one which focuses on albeit a valuable one for many people, not an end in resilience and recovery. end in its own right.’ its own right. The recovery paradigm proposes that solutions to For many individuals, recovery sustainability is severe substance use problems ‘have a long history not achieved in the short span of time that and are currently manifested in the lives of millions treatment agencies are involved in their lives. As I of individuals and families and that the scientific will explore in a later Briefing, we need something study of these lived solutions could elucidate additional to help people to recovery. principles and practices that could further enhance I finish with a story I’ve often heard: A person recovery initiation and maintenance efforts’. We also need to sit back and reflect on the current who wants to stop using heroin is put on a In the US, there have been calls to shift the paradigm being used in the UK – the intervention methadone programme. He later asks that his dose design of addiction treatment from a model of model – and how we are using it. We need to ask be gradually reduced so he can work towards being acute biopsychosocial stabilisation to a model of ourselves whether we are so wrapped up in the idea abstinent. He is told his dose cannot be reduced sustained recovery management. Moreover, a new of ‘treatment’ that we forget what we are really because he will relapse. recovery advocacy movement has developed. doing, or should be doing, for the majority of people Where is the focus: on his recovery (and Now you might be thinking, ‘What has this got to who need help, ie helping them find recovery. wellbeing) or on treatment? do with the UK?’ We’ve got our treatment system, we Some people who attend treatment are not [To be continued.] have a mantra ‘treatment works’, etc, etc. particularly interested in stopping using drugs or However, it has been pointed out to me on a drinking in the long term, or do not believe they are ‘Linking Addiction Treatment and Communities of number of occasions that in the treatment field we capable of doing so. They want some respite from the Recovery: A Primer for Addiction Counselors and tend to be 15 to 20 years behind the US, which chaos and damage that their substance use is Recovery Coaches’ by William White and Ernest means that this shift in paradigm will be coming. causing them. Support from street-based agencies Kurtz (2005). Moreover, we must note that the treatment system can provide a welcome period of respite, while a www.facesandvoicesofrecovery.org/pdf/White/r in the US was effectively dismantled in the 1990s. methadone programme can be beneficial for people ecovery_monograph_06.pdf

www.drinkanddrugs.net 22 October 2007 | drinkanddrugsnews | 15 Classified | training and services

Your chance to learn from an Intervention Specialist Professional Training Presented by Heather Hayes and Dr Kevin McCauley 26th & 27th November Cost: £245 Venue: Central London In this workshop, Heather Hayes – a licensed therapist and interventionist – will describe the history of this technique and outline the three main models of intervention. Dr Kevin McCauley will co-present and will address the medical aspects of addiction, outline a treatment plan for the first year of recovery and address ethical issues. To book your place please call 01483 757572 or email Emma at [email protected] LIFE WORKS TRANSFORMING LIVES WWW.LIFEWORKSCOMMUNITY.COM

AURICULAR ACUPUNCTURE TRAINING Specialist short courses for professionals working with substance misusers.

This simple and effective therapy can: Drug & Alcohol Teams, Social Services • Attract more clients into your service • Improve treatment outcomes LOOKLOOK NONO FURTHER!FURTHER! • Increase staff and client motivation No waiting lists – immediate beds available We promise to deliver:

LL LL LLLLL • Tailor-made courses to suit your needs 24 Hours, 7 Days a week care • Recognised certification 36 beds quasi residential Primary - £350 per week • DANOS compliancy 24 beds quasi residential Secondary - £300 per week 12 week programme Please contact us for a highly competitive quote We give you statistical information on line every week regarding your client without fail Carole Bishop BSc(Hons) DipAC, Detox facilitated MBAcC, GDAS 12 step and holistic therapy Janine Cousins BA(Hons), DipAc, CQSW,PGCE, CertEd For further information please contact Darren Rolfe Website: www.acupuncturetraining.co.uk CALL FREE 08000 380 480 Email: [email protected] Tel: 07999 816326 Email: [email protected] Web: www.pcpluton.com “Training For Practitioners By Practitioners.”

16 | drinkanddrugsnews | 22 October 2007 www.drinkanddrugs.net Classified | conferences Nothing about us without us! The first national service user involvement conference brought to you by DDN and The Alliance 31 January 2008, Birmingham Your opinions will help shape the strategy of the future Speakers Include: Vernon Coaker MP, Minister for Drugs & Crime Reduction Paul Hayes, NTA Chief Executive Jimmi Grieves, NUN Chair Service User group representatives

Plus! Evening benefit gig for The Alliance, featuring The Nightingales with special guests. For details email: [email protected] Full programme andbrochure now available at www.drinkanddrugs.net

2nd Addiction Psychology Conference Glaziers Hall, 9 Montague Close, London Bridge, SE1 9DD Friday 23rd November 2007

Our key note speakers; Beyond Stages of Change? G Professor Stephen Sutton Dept. of Public Health and Primary Care, University of Cambridge Alternatives to the Transtheoretical Model of Change G Dr Arie Dijkstra Dept. of Psychology, University of Groningen After the success of the inaugural event in 2006, the conference provides a unique G Professor W Miles Cox opportunity for students and professionals involved in addiction psychology to School of Psychology, Bangor University experience and share ideas, discuss and promote dialogue for the future. G Professor Robert West Dept. of Epidemiology and Public Health, University College London Tickets £78 for non students, £30 for students. Includes lunch and refreshments. Chairing the discussion sessions; BOOK NOW quoting “2nd Psychology Conference” G Professor Robin Davidson E-mail: [email protected] for further details and booking enquiries. Consultant Clinical Psychologist, Belfast City Hospital

www.drinkanddrugs.net 22 October 2007 | drinkanddrugsnews | 17 Classified | recruitment and training Essential workshops Creative ways of working with anger 16 November – central London Uncover many creative and practical ways to help you develop strategies in working with anger. This course is an opportunity to help you develop an understanding of anger. You will explore creative ways of approaching this complex emotion. During the day you will learn some useful techniques to help respond to situations rather than react and techniques to use with your client group. These workshops are led by one of the country’s leading anger therapist workers. Becky Wright who advocates that to feel confident in working with anger in others you first need to be able to understand how to develop a personal model which allows for your own anger to be explored. Becky has worked within the field of substance misuse since 1989. The essential drug and alcohol worker 3-7 December – central London This five-day course provides a full introduction to many of the elements of effective drugs and alcohol work. It is run by Tim Morrison, a member of The Competence Group and author of The Essential Drug and Alcohol Worker. This workshop is delivered in association with DDN and DrugScope. Cost: £635 + VAT per head (15% reduction for FDAP members/affiliates) – rates for groups on application.

Supervision, appraisal and DANOS 4 February 2008 – central London Performance management 11 February 2008 – central London Contact Tracy Aphra – e: [email protected], t: 020 7463 2085. DDNin association with FDAP

Substance Misuse Volunteering and Training Organisation NewLink Wales provides training for professionals working in the field of substance misuse, throughout Wales. Besides the courses on its annual training programme it can also provide in-house training designed to meet specific needs. Courses are mapped to units within the Drug & Alcohol National Occupational Standards. The organisation is also a registered centre for NVQs. NEWLINK WALES TRAINING COURSES, OCTOBER – DECEMBER 07

November November (cont) 1 & 2 Basic Substance Misuse Awareness Level One 26 & 27 Basic Substance Misuse Awareness Level One (Carmarthen) (Aberystwyth) (£110 – Voluntary Sector staff, £130 Statutory Sector staff) (£110 – Voluntary Sector staff, £130 Statutory Sector staff)

12 & 13 Basic Substance Misuse Awareness Level One 27 Working with Drug Using Couples (£110 – Voluntary Sector staff, £130 Statutory Sector staff) (£110 – Voluntary Sector staff, £120 Statutory Sector staff) December 15 Amphetamine & Methamphetamine (£110 – Voluntary Sector staff, £120 Statutory Sector staff) 4 Substance Misuse and Older People (£110 – Voluntary Sector staff, £120 Statutory Sector staff) 19 & 20 Dual Diagnosis (£120 – Voluntary Sector staff, £135 Statutory Sector staff) 10 & 11 Basic Substance Misuse Awareness Level Two (£130 – Voluntary Sector staff, £150 Statutory Sector staff)

Members of NewLink Wales are eligible for a 5% discount on training fees. All the above courses take place at our offices in Cardiff, unless otherwise stated. For queries, booking forms or information on courses please call NewLink Wales on Tel: 02920 529002 or e-mail us at [email protected]. Details of all the courses and workshops we offer can be found on our website: www.newlink-sw.org.uk Registered Company – 4142393 Registered Charity – 1085545

18 | drinkanddrugsnews | 22 October 2007 www.drinkanddrugs.net Classified | recruitment and tenders

NATIONAL DRUG PROGRAMMES DELIVERY UNIT, HM PRISON SERVICE The National Drug Programmes Delivery Unit is responsible in the Prison Service for the SLOUGH monitoring and delivery of high quality drug treatment programmes throughout the prison DRUG & ALCOHOL ACTION TEAM estate in England and Wales.

Slough Drug and Alcohol Action Team are seeking written expressions of interest from providers with Manager G – Training Team (1 post) proven experience in delivering the Drug Intervention Programme Salary range £ 23,434 – £30,676 (DIP). You will be required to provide the following services:

Arrest Referral, Assessment, PPO/Prison liaison, Through- care and Aftercare, Comprehensive Assessment, Urine The post holder will join the Training Team of the National Drug Programme Delivery Screening and Key Working with a case load that includes Unit. The post holder will be required to carry out assessments of potential facilitators, those accessing rapid prescribing. Treatment managers and Deputy Treatment Managers in all areas of the country and deliver a minimum of 80 days training per year. The expected terms of the contract will be for two years with a possible two-year extension in twelve-month increments, Experience of facilitating/treatment managing accredited subject to evidence of need, recurrent funding and satisfactory drug treatment programmes in a custodial or community performance. You will be required to commence services on 1st April 2008. setting is essential

Applicants will be required to show how they will ensure that For further information about this post please contact the DIP is delivered as part of a wider adult drug treatment Andy Clark (Training Manager) 01902 703149. system. They should be able to identify other providers and For an application pack contact Theresa Breuilly on explain how they will work with those providers to deliver a complete package of care. 01902 703156 or e-mail [email protected] Closing date: 2 November 2007 Expressions of interest should be sent in writing to: Julia Wales, Slough DAAT, Town Hall, Bath Road, Interviews will take place in November. Slough, SL1 3UQ. [email protected] and should arrive no later than 5th November 2007. Please note that all Prison Service posts are open to part-time and job share applications. Applicants are require to declare whether they are a member of a You will then be issued with a Pre-Qualification group or organisation which the Prison Service considers to be a racist. The Questionnaire (PQQ), which must be completed and Prison Service is an equal opportunities employer. We welcome applications from candidates regardless of ethnic origin, religious belief, gender, age returned by 12th November 2007. (subject to being within normal retirement age for grades) sexual orientation, disability or any other irrelevant factor.

Substance Misuse Jobs Across the UK LANCASHIRE CARE NHS TRUST Service Care Solutions are a specialist agency Are interested in developing a range of strategic business partnerships. We wish to establish working arrangements with suitably experienced and for drug and alcohol staff across the UK. resourced organisations with a proven track record in a number of areas: To apply or register: Substance misuse services and community alcohol services Email: [email protected] We are seeking to identify third sector providers who would be willing to work Freephone: 0800 311 2020 collaboratively with us in identifying innovative ways to provide a range of substance Land line: 01772 889722 misuse services and/or community alcohol services in a partnership model. Web site: www.servicecare.org.uk We have vacancies across most of the UK. We offer free career advice and a free CV Strategic development and exploitation of estates and facilities We are planning significant strategic change in our extensive property portfolio review service. Please call or email your details for more information including a complete reconfiguration of in-patient facilities. We would be interested in hearing from specialist organisations that can help us exploit the opportunities that will arise over the next decade.

Rehabilitation services and supported accommodation (including forensic) We aim to develop our services in this area and are keen to talk to potential partners who can bring new approaches to managing accommodation or providing care or a combination of both.

Registered care home or nursing home providers We are involved in a number of specialist services, such as Huntington’s Disease, and would like to discuss innovative ways of providing integrated care pathways in these areas. We are again looking for new approaches to managing accommodation or providing care or a combination of both.

Written expressions of interest are invited from organisations. Please provide a summary of proposals (at this stage maximum three pages A4 for any of the four areas), together with supporting information about your organisation, including copy of latest financial information. The closing date for expressions of interest is 1 November 2007.

All correspondence should be via e-mail to: [email protected] with subject ‘Drink and Drugs News tender’

www.drinkanddrugs.net 22 October 2007 | drinkanddrugsnews | 19 STILL NUMBER 1 FOR RECRUITMENT AND CONSULTANCY SOLUTIONS 020 8987 6061

Important to us: INTEGRITY... we are built on it DELIVERY... we achieve it Important to you: VALUE... we provide it Call today to discuss your consultancy and recruitment needs, or register on-line at www.SamRecruitment.org.uk

Two part-time posts on our Addiction Recovery Programme

Counselling Manager – 25 hours per week (£25k) We require a part-time Counselling Manager to manage our programme. They must have thorough knowledge and experience of managing a 12-Step Treatment Programme, working with clients with dual-diagnosis and working with families. They must be accredited with either the BACP and/or UKCP and be a qualified supervisor.

Addictions Counsellor – 2.5 days per week (£27k pro-rata) We also require a part-time Counsellor to work on our programme. They must have knowledge and at least one year’s experience of working in a 12-Step Treatment programme, group work and one to one counselling. A minimum of a diploma qualification required. Pre-Qualifying Questionnaire Notice For more information or to submit your CV, please contact Toni-Dee Downer at [email protected] and we will send you Staffordshire Drug and Alcohol Action Team an application form with the full job description. Closing date: 16 November 2007 1. We are inviting suitably qualified organisations to: Submit 2 Pre-Qualifying Questionnaires Interview date: 22 November 2007 for a Staffordshire wide Prescribing and Inpatient Detoxification Service valued in the region of £1,750,000 to £2 Million. 41 Abbeville Road, Clapham, SW4 9JX Tel: 0208 673 4545 References for the PQQ’s are as follows: www.theawarenesscentre.com PQQ code rfi 28554 SCDAAT All Services PQQ2. PQQ code rfi 28551 SCDAAT Prescribing and Inpatient only additional questions. The final date and time for receipt of the above PQQs is: Friday 30th November 2007 at 3.00pm. Brighton Oasis Project, South East Winners of the 2006 Home Office Tackling Drugs, Changing Lives Awards are Following short listing successful applicants will be invited to participate in a scoping celebrating their tenth year this year and are seeking to appoint a new exercise which will be held during February to March 2008. It is envisaged that the contract will be awarded in September 2008 and that the Service Substance Misuse Worker will be operational from 1st April 2009. 22.5 hours per week, (female*) Aiming to Salary: NJC point 26 £20,895 pro rata per annum reduce drug- 2. In addition, the Supported Community Detoxification Service PQQ will be re-opened to related harm This post will join our Adult Services Team who offer accept new applications. The Contract will be revised based on constructive feedback from to women and Open Access, Key-Working, Structured Day Care, an specialist sources. It will be awarded in April 2008 and be operational from July 2008. their families Activities Programme and After-Care Support. Applicants must have an understanding of and experience of Submissions for a Pre-Qualifying Questionnaire should be made by delivering substance misuse or therapeutic interventions Friday 9th November 2007 at 3.00pm and submission of the full Tender and an ability to plan and review integrated document by 30th November 2007 at 3.00pm programmes of care for women substance misusers. Closing date for applications: The reference for the Supported Community Detoxification Service is: 4pm on Monday, 5th November 2007 PQQ code rfi 28554 SCDAAT All Services PQQ2 ITT Supported Community Detoxification Service. For further information, please call Jo-Anne Welsh, Interim Director on 01273 696970 and for an application Information will be available and accessible on the website from the 29th October 2007. pack (please note we cannot accept CV’s) please ask Please note previous applicants who have already submitted a PQQ for this service need Wezi or telephone 01273 696970 (24hr answerphone) not complete another PQQ but should complete the form of Tender by the due deadline. or e-mail [email protected] (state your name, address and post you are applying *This post is exempt under para 7 (2) of the Sex Discrimination Act The PQQ can be located by accessing the on-line ‘BravoSolution’ Electronic Sourcing system. BOP is committed to equal opportunities and welcomes To download browse the Sourcing Portal: applications from people with relevant life as well as www.wmcoe.bravosolution.com/web/login.shtml professional experience, and those with disabilities who Click the “Click here to register” link to follow the process. are currently under-represented in the organisation. Charity no: 1065503 Company no: 3447762 DAAT contact details: Louise Stone, Head of Service, 01785 223176. www.oasisproject.org.uk